Complications of Severe Constipation

Severe constipation, acute or chronic, has to be treated promptly, otherwise below mentioned complications may develop.

Bloating

Bloating is common in constipated persons; prolonged stool passage enables colonic bacteria to break down more fibres and hence produce more gas. Finding appropriate food and avoiding carbonated drinks may help. Tiredness may be related to constant annoying abdominal discomfort.

Lazy Colon

Lazy colon is a term which denotes slow colonic transit time or in extreme cases colon inactivity. It is a result of long term laxatives abuse, postponing bowel movements or prolonged bed rest. Colonic peristalsis react only weakly on presence of stool and even on laxatives. Affected person often doesn’t feel the urge for defecation. Lazy colon is a kind of synonym for a severe chronic constipation. Eliminating the cause is the only solution.

Fecal Impaction

Fecal impaction refers to sticking of a solid stool bolus in the colon which is impossible to expel by patient’s natural effort. It typically occurs in old bedridden patients but can also affect adults and children. Sensation of fullness or pain in the rectum, urge to defecate, abdominal discomfort, cramping, nausea and frequent urge to urinate may be present. Clear stool may pass impacted stool; this is called paradoxical diarrhea. Hard fecal mass may be palpated in the lower left part of abdomen. It can be removed by a patient with a finger or by doctor under local or general anesthesia, or with water irrigation using sigmoidoscope. Glycerin suppositories or phosphate or arachis oil enema may also be used. If impaction is higher in the colon then orally taken polyethylene glycol electrolyte solution (otherwise used for preparing for colonoscopy) should be used carefully under doctor’s control. Rarely operative removal of impacted stool is needed. Foods that cause constipation

Obstipation

Obstipation refers to severe constipation caused by intestinal obstruction which may be acute or chronic, complete or partial. Constipation, abdominal distension, painful cramps and vomiting are main symptoms. Obstruction may be caused by a polyp, cancer, scar tissue developed after surgery or inflammation, volvulus (intestine twist upon itself – congenital defect found in infants), intussusception (telescoping, when one part of intestine slips into adjacent part; found in infants and young children (other causes of infant constipation)), hernia, gallstones or foreign bodies. Some diseases like scleroderma, lupus, amyloidosis change the composition of colon wall which than cannot transmit peristalsis waves. It is usually diagnosed with ultra sound. It has to be solved quickly by operation, since bowel perforation, bleeding or infection may follow.

Rectal prolapse

Rectal prolapse is protruding of a part of rectum through anal opening during defecation. It occurs as a combination of straining and weak pelvic floor, mostly in old people. Full-thickness rectal prolapse usually causes constipation while mucosal prolapse doesn’t. Bulking laxatives or stool softeners are appropriate in mild cases, sometimes surgery is needed.

Rectocele

Rectocele, mostly found in women after menopause is a bulging of rectum forward toward vagina. It happens after heavy vaginal delivery or constant lifting of heavy loads. The stool may be then trapped in the bulge. This bulge can be felt and palpated during vaginal and rectal examination. Kegel exercises to strengthen muscles of pelvic floor may help in mild cases (1). If rectocele protrudes through vagina, surgery is usually needed.

Urinary incontinence or infection or incomplete urine excretion are often connected with constipation where the rectum is full of hard stool.

Anal Fissure

Anal fissure is a tear of anal mucosa and is mostly a consequence of forced passing of large and hard stool (2). When it occurs, a severe pain which can last for many hours is felt. Next defecations are painful, blood may be found on the stool or toilet paper. Treatment: Warm sitz baths for 10-20 minutes few times a day sooth anal muscles, stool softeners enable soft passage of the stool, local analgesic creams relieve the pain. Tear usually heal completely on its own in few weeks. Sometimes surgical sphincterotomy or anal dilation is needed.

Chronic Hemorrhoids

In chronic hemorrhoids, aggressive treatment with fibres, water, exercise, sitz baths and local symptomatic treatment should be tried before surgery. Acute hemorrhoidal thrombosis is present with very sensitive, bluish and hardened hemorrhoids and requires urgent surgical removal of a clot.
Repeated injury of anal sphincter by hard defecation may lead to patulous (widened, spreading) anus with diminished anal sphincter tone.

Non-intestinal Complications

Heavy straining may trigger heart attack or stroke. Holding breath and exerting raises the pressure in the chest cavity, preventing the blood to enter the right heart atrium. When the breath is released, the intra-thoracic pressure drops and the trapped blood is quickly propelled through the heart, producing an increase in the heart rate and the blood pressure. Immediately after that heart rate reflexively slows down and this may trigger heart attack in vulnerable persons. By the same mechanism suddenly increased and then decreased blood flow in brain cause transient brain hypoxia. Additionally a blood clot may be dislodged from atherosclerotic brain arteries thus causing stroke. These are two causes of not so rare “toilet deaths” – they mostly occur in old people with severe atherosclerosis. Squatting position greatly reduce the need for straining on defecation.

References:

1. http://mayoclinic.com/health/kegel-exercises/WO00119 KEGEL EXERCISES
2. http://webmd.com/digestive-disorders/tc/Anal-Fissure-Topic-Overview ANAL FISSURE

This article is the property of http://www.HealthHype.com
Copying and publishing any article from our site is strictly NOT allowed.


Further Reading :
  • Causes of Bloating and Gas (Flatulence)
  • Chronic Constipation – Diagnosis and Treatment